St. Jerome Regional CYO Registration
Please complete the following registration form for each child you wish to have participate in the St. Jerome Regional Catholic Youth Organization for the 2018-2019 season. Please including the information as noted for each field. In addition, a completed medical waiver and multimedia release form must be submitted prior to participation (form can be found on www.sjrschool.com)
Student Last Name *
Your answer
Student First Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
Grade *
Your answer
Parish *
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Name(s) *
Your answer
Address (if different from above)
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number (please specify if it is a cell phone) *
Your answer
Email *
Your answer
Registration fee is $10 per sport
The registration fee will be used to cover the cost of team supplies and officials where necessary. For 2018-2019 the fee is $10 per sport, per student. Fee will be collected at the organizational meeting/practice for each sport. Fees are non-refundable.
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